Basic Information
| Provider Information | |||||||||
| NPI: | 1891719712 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BECKER | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40000 | ||||||||
| Address2: | |||||||||
| City: | VAIL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816587520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704762451 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1252 COUNTY RD 8 | ||||||||
| Address2: | |||||||||
| City: | KEYSTONE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804358043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704866677 | ||||||||
| FaxNumber: | 9704867908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 06/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | MD12086 | RI | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | 207P00000X | DR.0063634 | CO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | MD12086 | RI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | MD06899 | RI | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02/28/2006 | 01 | RI | NHPRI | OTHER | 04/15/2009 | 01 | RI | UNITED HEALTHCARE | OTHER | 07/01/2007 | 01 | RI | BCBS | OTHER | 939025129 | 01 | RI | RI MEDICARE GROUP NUMBER | OTHER | 1891719712 | 01 | RI | NPI | OTHER | 12/29/2008 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 6183921 | 05 | MA | MEDICAID | 7000113 | 05 | RI | MEDICAID |